Israel becomes first country to earn World Health Organization's highest ranking for its field hospital unit

A nepalese baby is treated by Israeli Army medic soldiers at the Israeli field hospital on the second day of their mission in Kathmandu on April 29, 2015. (AFP/ MENAHEM KAHANA)

The United Nation’s World Health Organization recognized the Israeli army’s field hospital, which is regularly sent abroad to provide aid at natural disaster sites, as “the number one in the world” in a ceremony last week, classifying it as its first and only “Type 3” field hospital, according to its commander, Lt. Col. (res.) Dr. Ofer Merin.

As reported in The Times of Israel last month, the WHO and the Israel Defense Forces had been in talks to determine if the army unit met the demands of a “Type 3” medical team, a status no medical team had ever reached before.

Last Wednesday, the IDF’s field hospital team received the “Type 3” designation, along with some additional “specialized care” recognitions, which technically made it a “Type 3 plus,” though the army kept the information quiet until Sunday.

“We’re going to recommend the director-general verifies [Israel’s team] as a Type 1, Type 2, and also Type 3 and multiple different types of specialty cells,” Dr. Ian Norton, the lead author of the classification system and head of the WHO delegation, said Wednesday at the ceremony in the Medical Corps’ base in Ramat Gan, outside Tel Aviv.

A 26-tent IDF field hospital set up during an exercise in Beit Naballah, in central Israel, on December 9, 2013. (IDF Spokesperson’s Unit)

“We haven’t had that ever before,” Norton said, praising the months of work put in by the Israeli team to receive the designation.

Israel will receive official WHO patches noting the new designation, and members of the IDF’s Medical Corps, including Merin, will meet with the head of the international organization at a formal ceremony in Hong Kong at the end of the month, the army said.

Head of the World Health Organization’s delegation, Dr. Ian Norton, center and Dr. Dorit Nitzan, the WHO’s representative in Israel, left, speak with the head of the IDF Medical Corps, Brig. Gen. Dr. Dudu Dagan in the unit’s base in Ramat Gan, outside of Tel Aviv, on November 9, 2016. (IDF Spokesperson’s Unit)

The United Nations is generally seen as having a negative attitude toward Israel, giving this recognition of the IDF’s abilities some additional weight, Merin said.

The representatives from the World Health Organization were “not biased, not one bit,” he said.

In 2013, the United Nation’s WHO created a set of criteria to classify foreign medical teams in sudden onset disasters, on a scale from one to three. Israel is now the only country to receive the top mark. “Only a handful in the world could even think of” doing so in the future, Norton said in a conversation with The Times of Israel last month.

In a phone conversation with reporters on Sunday, Merin, who has personally invested “hundreds of hours” in the recognition process, described the experience of having the work he and his team have done be classified as the best in the world as “emotional.”

“I wish I could sit here and say it’s a ‘Mazal tov’ for me, but it’s a ‘Mazal tov’ for the army, for Israel,” Merin said, using a Hebrew term that literally means “good luck,” but is used as “congratulations.”

The recognition process took nearly a year, beginning in January 2016, most of that meticulously reviewing manuals and ensuring that Israel met the criteria, Merin said.

The IDF Medical Corps shows off its field hospital to a delegation from the World Health Organization, in an undated photograph. (IDF Spokesperson’s Unit)

In the past two months, WHO delegations also visited Israel and met with Merin and his team in order to assess the IDF Medical Corps’ field hospital, a sprawling structure that can comprise up to 30 tents, according to the IDF. However, the version seen by Norton’s team during an exercise in northern Israel in September contained just 26.

The military’s field hospital is “not just some medics and doctors spread out in the field”; rather it is a “national treasure” that has the capabilities of an advanced, permanent hospital but can be set up almost anywhere in under 12 hours, Merin told The Times of Israel last month.

Israeli disaster relief delegations — some of them led by Merin — have been some of the first and largest to arrive at the scenes of natural disasters. Teams from the IDF Medical Corps and Home Front Command provided rescue and medical services after an earthquake in Turkey in 1999, an earthquake in Haiti in 2010, a typhoon in the Philippines in 2013 and, most recently, an earthquake in Nepal in 2015.

Injured Nepalese women wait to be treated by Israeli army medics at the Israeli field hospital on the second day of their mission in Kathmandu on April 29, 2015. (AFP/ MENAHEM KAHANA)

This Type 3 classification ensures that Israeli teams will continue to be the first allowed on the scene of future disasters and further cements Israel’s position as a world leader in emergency medicine, proving to friends and foes alike that the Jewish state knows how to handle catastrophes.

“This recognition isn’t just international. It’s also recognition for ourselves, showing us what we can do,” the army spokesperson said Sunday.

While Israel’s emergency medical teams may be best known for their work abroad, Merin stressed that this takes a backseat to its primary directive.

Lt. Col. (res.) Dr. Ofer Merin, commander of the IDF Medical Corps’ field hospital and head of the trauma center at Jerusalem’s Shaare Zedek Medical Center, on October 11, 2015. (Hadas Parush/Flash90)

“Our role is, first of all, to deploy and assist in either — God forbid — a natural disaster, which can happen because Israel’s on an active [fault line] or in cases of war,” he said.

Israel’s regular humanitarian relief efforts have drawn both international praise and accusations of “rubble-washing” — or using its disaster relief effort to boost its international standing.

Helping other countries in need is “the most effective kind of diplomacy,” then-foreign minister Avigdor Liberman said in 2015, after Israel sent a team to Nepal. “In crafting a country’s image, nothing is more effective than providing aid.”

However, diplomats insist the drive is mostly altruistic.

IDF officials and Nepalese officials in a closing ceremony of the Nepal field hospital on May 10, 2015 (IDF spokesperson’s Unit)

“If we’re sending aid to Haiti, the Philippines and Nepal, we’re obviously not looking to reap great diplomatic benefits from these countries, which I might be allowed to describe as not superpowers,” said a former senior diplomat in 2015, responding to a question about Liberman’s comment.

Combating unhelpful aid

For many years there was no internationally recognized system of categorizing emergency response teams — which could operate independently, which needed assistance from the local government in order to function, what services could they offer, etc. — information that can be crucial in a disaster situation.

Rescue workers need to know where they can take patients. When deciding which teams can come in as part of the relief effort, local governments need to know which foreign field hospitals are entirely self-sufficient and which require resources like fuel, oxygen and medications that are often scarce after a disaster.

“They cannot be a burden on the affected country. In the past, teams arrived with no equipment, and local authorities had to look after them; we found that inappropriate,” Norton said.

Dr. Ian Norton, from the World Health Organization, takes part in Australia’s disaster relief effort in The Philippines after a typhoon wreaked havoc on the island nation in 2013. (Gemma Haines/ Australian Department of Foreign Affairs and Trade/Wikimedia)

A specialist in emergency medicine and former head of his native Australia’s emergence response team, Norton joined the WHO in 2013. That same year, he and a team of other experts developed the WHO’s classification system, which puts foreign medical teams into three groups: Type 1, Type 2 and Type 3.

The document detailing the requirements for these classifications is some 91 pages long, but in short, the types are in ascending order by number of patients that can be treated and level of difficulty of the procedures that are offered.

A Type 1 medical team can offer first aid and other immediate emergency care on an outpatient basis, meaning the victims do not remain in the hospital for extended periods of time; a Type 2 has at least 20 beds for inpatients and can perform 7-15 surgeries per day; and a Type 3 has twice as many inpatient beds, an intensive care unit and can perform 15-30 surgeries per day, as well as provide a host of other services, including rehabilitation.

Israel’s field hospital blows past some of these requirements: A Type 3 field hospital needs 40 inpatient beds, Israel’s has 86. A Type 3 needs two operating rooms, Israel’s has four.

A woman shortly after giving birth at the IDF’s field hospital in Bogo City, the Philippines. (Shay Wagner/IDF Spokesperson’s Unit)

Israel, in addition to its Type 3 designation, was also recognized for its abilities in the latter two categories, plastic surgery and OB/GYN care, making it a “Type 3 plus.”

Merin, wary of bragging, said, “We’re already standing on the podium. I don’t think we need that. We’re already recognized as the only Type 3 team in the world. It’s good enough.”

Some aspects of the classification were not simply an issue of which specialists are on staff or the amount of oxygen the facility can produce per minute, but deal with the ethics of emergency care.

“We also ask them to comply with the principles of being an emergency medical team, which means they will behave ethically in the field, that they will treat anybody no matter race, color or creed and that they will take part in the combined and coordinated effort to do the best for people affected by the disaster,” Norton said.

‘We learned a lot. All of us will be able to deploy better to our missions in the future’

To ensure that the IDF team will follow those principles, Norton said, “we look at how they teach the teams, but we also ask the director-general and the chief surgeon to sign on behalf of the organization that they will do their best to comply.”

According to Merin, the recognition process not only gives Israel the credibility it needs to operate around the world, but has actually improved the level of treatment his team can provide.

“We learned a lot. All of us will be able to deploy better to our missions in the future,” he said.

Preferred access to disasters

Israel is now the 17th foreign medical team to be classified by the WHO, Merin said, though dozens more have already requested a review.

The Type 3 classification, besides its value as recognition for recognition’s sake, will also have some real world ramifications for the future.

‘It’s a proud moment for all the Jews around the world and for people from Israel and for people from the IDF Medical Corps’

Israel will now get “preferential access to disasters in the future,” Norton said.

The concept of “preferred access” to natural disasters may sound strange, until you consider situations like the one in Haiti in 2010, where groups arrived with medical personnel that were not properly trained and supplied, and ended up becoming more of a drag on the local government than a boon to the relief effort, Norton said.

Merin, who served in many of these disaster sites, also noted the phenomenon of countries sending delegations that were unprepared or unable to provide the services required, and the WHO’s need to determine who would be allowed to help in the future.

Israeli soldiers set up a field hospital in Nepal, following the deadly earthquake on April 28, 2015. (IDF Spokesperson’s Unit)

“I’m not saying that people didn’t do the right thing. But people did what they thought was the right thing to do in that disaster. So they said, no, this is how you have to operate in these areas,” Merin said Sunday.

In total, according to Norton, nearly 200 teams, including some non-governmental groups in Israel, are eligible for the process. However, most of these are of Type 1 and Type 2 classifications.

“We don’t actually have any other Type 3’s that are in the process of being verified,” Norton said last month.

Only a pan-European collaboration and a Chinese team stand to receive one in the foreseeable future, he added.

In addition to being the only Type 3 team in the world, Israel’s is also the only one with a “military component” that has been recognized by the WHO.

“It’s a proud moment for all the Jews around the world and for people from Israel and for people from the IDF Medical Corps. It’s great moment for all of us, really. It’s a great moment,” he said.

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